Max Gawlich: “Electroconvulsive Therapy and Its Devices”

In 1939 a wave of enthusiasm swept through the asylums of Europe. Machines and circuit diagrams originating from Italy, but often only the idea of electrically induced convulsions seized the imagination of psychiatrists. In this dissertation project I study the years of 1938 to 1950 as the period of early adoption and beginning routinization of electroconvulsive therapy (ECT). The history of somatic therapy in mid-century psychiatry remains under-studied, often undervalued as mere precursor of psychopharmacological therapies since the development of Chlorpromazine in the 1950s. On the other hand, next to Lobotomy ECT continues to be the infamous therapy of a disciplining and punishing psychiatric regime, dominating as such the critical discourse about psychiatry since the 1970s. The historical question what ECT was, how the machines were built, what those devices did and how they were adopted in the contexts of asylums remained unanswered.

The study compares three large asylums in Europe which were among the earliest to adopt therapeutic innovations in general and ECT in particular: Eglfing-Haar, south-east of Munich in the German Reich; Münsingen near Bern, Switzerland; and Warlingham Park Hospital in South-London, England. Eglfing-Haar was one of the largest asylums in Europe at the time, infamously known for both its function as relay-station for the transfer of patients into asylums where they would be killed as well as its establishment of so-called starvation units in which patients were murdered through neglect and overdoses of opiates. Münsingen was an internationally acclaimed centre for the so-called somatic therapies like insulin-coma therapy or sleeping-therapy and served as a hub for medically trained refugees fleeing the persecution in the German Reich or Italy. Warlingham-Park Hospital was the first British asylum to adopt ECT besides the Burden Neurological Institute. Its Super-Intendent Thomas P. Rees was famous for his reformist zeal opening the gates of his clinic in 1936.

Siemens Konvulsator II – booklet

The source-material of my project is structured mainly by two institutional contexts. First there is the archival material from asylums, meaning mostly patient-files and therapy-registers. The second group are files, correspondence, brochures, and circuit-diagrams created in the development-process either at the Ediswan Co. in Britain or the Siemens-Reiniger-Werke in Erlangen. The opportunity as well as challenge was to develop a framework in which both kind of source materials complement each other and enable new questions and perspectives on clinical therapy with machines in asylums. To achieve this, I focus on 1) records and inscriptions of ECT, 2) the technical evolution of ECT-Devices in the period from 1938 to 1950, and 3) the therapeutic practices utilizing those devices. I further argue that with somatic therapies also the evaluation of those therapies was introduced. Contrary to previous research, my dissertation will show how psychiatrists involved in somatic therapies developed methods to record therapy, add up data and present statistical evidence supporting their claim of clinical success. Not only were the development and utilization of devices deeply entangled, but also questions of dosage, security, or wanted and unwanted effects were technically as well as practically addressed. Institutional settings, personal preferences and the design of ECT –devices produced specific adaptations of ECT in the local spaces of each asylum. The Second World War hindered the exchange of ideas and concepts of ECT, and rather strengthened the position of Swiss psychiatrists as intermediaries in the international transfer of knowledge. The War created a situation of largely isolated developments, producing specific technical and therapeutic solutions, which demands a comparative perspective and explicative approach.